The patient was operated by me 21-August-2002 for huge PCD C6-7 causing malacia of the spinal cord and recovered after then. The patient then came  to the clinic 30-October-2011 complaining of LBP with left sciatica for 3 months. He could walk only 300 meter with difficulty.

MRI lumbar spine performed 18-August-2011 showing huge extruded disc L4-5 more to the left with severe segmental stenosis.

On examination: the patient is limping with exaggerated scoliotic stance. There is weak dorsi and planterflexion left foot 4/5. There is dyseasthesia left L5 and S1 territories. SLRS was 40 degrees with pain in the left.

Decompressive partial laminectomy of L4 and L5. Bilateral flavotomy with bilateral L5 foraminotomy with more extension to the left L5 root. The extruded disc was removed from under the left L5 root and left sided cleaning was performed. Right sided cleaning of L4-5 disc space was done until all the possible removable disc fragments were achieved. The epidural fat was missing in the left side of the dural sleeve.

Routine closure of the wound.  Smooth postoperative recovery with improvement of the power of both feet.

The patient has huge extruded disc which will not resolve, until surgical decompression is achieved.

The estimated postoperative recurrence rate in this case is around 7% because the disc height still not shallow.

When huge disc with severe stenosis, it is preferable to perform bilateral cleaning to minimize the recurrence rate and to decrease the height of the disc space symmetrically.